Sleep Disruptions in Dementia Care Demand a New Approach
by Jeff McSpadden, Co-Founder & CEO at Composure
The following article is Part 1 of an ongoing series “Reimagining Sleep in Dementia Care”. It was originally published on LinkedIn, January 7, 2025.
For older adults living with dementia, sleep is often a significant challenge. Not just a nighttime inconvenience, poor and insufficient sleep is a pervasive issue that can accelerate cognitive decline, heighten agitation, and place immense strain on caregivers. Despite the well-documented importance of restorative sleep, traditional dementia care environments are rarely designed to promote it.
There are solutions. Addressing poor sleep requires a shift away from reactive, symptom-masking measures and toward comprehensive, innovative solutions. To do this, we must first explore the importance of quality sleep for health and well-being, the common causes of sleep disruptions in dementia care, and the emerging solutions that are redefining care practices.
Dementia & Sleep Are Connected
Up to 70% of people with dementia experience sleep disturbances, contributing to lowered coping abilities, cognitive decline, and caregiver burden (Alzheimer’s Society of Canada). Dementia disrupts the brain’s ability to regulate sleep-wake cycles. As a result, individuals may experience “sundowning” (an often misunderstood phenomenon), frequent waking, and increased distress during the night.
Regular, restorative sleep is essential for:
- Cognitive Function — Sleep supports memory consolidation and helps remove toxins from the brain (NIH), potentially slowing cognitive decline.
- Emotional Stability — Poor sleep heightens anxiety, aggression, and depression, exacerbating symptoms of dementia.
- Physical Health — Sleep helps regulate immune function, cardiovascular health, and mobility.
Without consistent, restorative sleep, individuals with dementia face a faster rate of decline, which in turn elevates caregiver burnout and stress.
The Challenge to Sleep in Today’s Dementia Care
Standard dementia care practices often fall short in fostering environments conducive to sleep. Current approaches often overlook key areas essential to fostering restorative sleep, beginning with the environment itself.
Environmental Design and the Sonic Landscape
Most dementia care environments prioritize safety and accessibility over sleep quality. While physical hazards are addressed, sensory hazards — particularly noise — are overlooked.
- Distracting Noises — Alarms, doors opening/closing, and nighttime staff activity unintentionally create a sonic environment that fragments sleep.
- Lack of Auditory Control — Sound waves are very difficult to isolate and control. Unexpected noises can startle residents awake, exacerbating confusion and agitation.
Over-reliance on Sleep Medications and Antipsychotics
Pharmacological interventions are often the default response to sleep disturbances in dementia care. However, these come with significant risks:
- Sedation and Fall Risk — Sleep medications increase the likelihood of falls and injuries. (NIH)
- Negative Cognitive Impacts — Long-term use of antipsychotics can accelerate cognitive decline and contribute to greater confusion (NIH).
- Limited Effectiveness — Medications treat the symptoms of poor sleep, not the root causes, offering only temporary relief.
Sleep Schedule Irregularity
Getting 7–9 hours of sleep each night is fairly common knowledge. However, recommendations from the National Sleep Foundation suggest that getting sleep at the same time each night is crucial for improving and maintaining overall sleep quality. Keeping a regular bedtime schedule can be particularly challenging for individuals with dementia. And for staff in busy care settings? It can be nearly impossible for frontline caregivers to support regular bedtimes for each resident on a consistent basis.
The Cost of Inaction
The challenges of dementia care can feel insurmountable, often leading to inaction that perpetuates avoidable suffering and inefficiency. Addressing sleep disturbances offers a powerful opportunity to improve resident health and reduce operational costs.
Poor sleep drives expenses across healthcare, staffing, and compliance, with the full financial toll difficult to quantify. Yet, studies like those from The Journal of Clinical Sleep Medicine estimate sleep disorders cost the U.S. over $94 billion annually in healthcare alone.
Breaking this cycle demands fresh thinking and openness to innovative solutions that enhance sleep, ultimately transforming quality of life, care standards, and operational efficiency.
Regulatory Focus Is Shifting Towards Non-Pharmacological Care
Recent updates to CMS guidelines are driving a shift away from pharmacological interventions in favor of non-pharmacological approaches. Non-compliance can lead to penalties, lower ratings, and damages to a communities reputation. According to CMS, facilities that fail to reduce antipsychotic use through non-pharmacological approaches risk losing a portion of Medicare reimbursements, a critical source of revenue for many operators.
Beyond imposing stringent guidelines, CMS offers their Dream Toolkit which highlights non-pharmacological strategies essential for improving sleep and reducing agitation, reinforcing the need for holistic, resident-centered care that can simultaneously improve outcomes and protect financial stability.
The Path Forward: Innovation as Compassionate Care
The future of dementia care lies in reimagining environments that prioritize sleep health. Technologies like Sound Blanket™ represent a new frontier — using auditory design to create restful, supportive spaces that enhance well-being without disrupting caregiver routines.
By addressing the factors affecting sleep, care communities can innovate, improve outcomes for residents and staff, and comply with evolving regulatory standards — all while reflecting a deeper commitment to compassionate, person-centered care.
As we continue this series, we’ll explore these challenges in greater depth, offering insights into the innovative solutions that are reshaping dementia care. The opportunity to change lives is here — everyone deserves restful nights, and it can be a reality for all.
Continue following our series “Reimagining Sleep in Dementia Care” for insights on advancing care practices through innovative, evidence-based solutions.
Read Part 2:
